FRCEM Revision Guide • System based OSCE Stations • St Emlyn's

Examiner / observer · 1 of 3

Abdominal examination

Preparation · Hands and pulse

Provide a couch, cover and stethoscope. Agree exposure and positioning. Intimate examinations are discussed only; they are not performed on a practice partner.

History and general inspection

Asks why the patient has come to hospital and checks where it hurts.

Looks for discomfort, jaundice, distension, scars or drains, chronic liver-disease signs and generalised oedema.

Hands and pulse

Assesses warmth and clamminess.

Palpates the pulse.

Assesses pulse rate.

Assesses pulse rhythm.

Assesses pulse quality.

Inspects for clubbing, leukonychia, palmar erythema, Dupuytren’s and liver flap.

St Emlyn’s · FRCEM · Practice aid, not an official mark schemeObserver 1 of 3

Examiner / observer · 2 of 3

Abdominal examination

Observations · Abdominal assessment

Observations

Requests or measures relevant observations, including blood pressure, respiration, saturation, temperature and glucose.

Face and lymph nodes

Checks conjunctival pallor, angular stomatitis, oral ulcers and relevant cervical or supraclavicular nodes.

Abdominal assessment

Positions the patient comfortably and examines from their right side while watching for discomfort.

Inspects the abdomen, including the left flank.

Starts away from pain, palpates gently then more deeply only if appropriate, and assesses tenderness, guarding, rigidity and masses. Key step

Assesses the liver, spleen, kidneys, bladder and aorta as appropriate.

Percusses the liver, spleen and bladder; assesses shifting dullness when indicated.

Auscultates bowel sounds and relevant femoral bruits.

St Emlyn’s · FRCEM · Practice aid, not an official mark schemeObserver 2 of 3

Examiner / observer · 3 of 3

Abdominal examination

Completion · Finish

Completion

Chooses lymph-node and hernial-orifice examination when relevant.

Explains that rectal, genital or pelvic examination needs a clinical indication, separate consent and chaperone discussion. Key step

Selects urinalysis, specified blood tests and imaging for the scenario, stating what each will help establish.

Finish

Thanks the patient.

Restores comfort and offers help with dressing where needed.

Ask the candidate

How do the findings change your differential? Summarises relevant positive and negative findings, including peritonism or masses if actually found. Explains targeted further assessment and its purpose.

Would an intimate examination add useful information? Identifies a specific indication and the separate explanation, consent and chaperone discussion it would require.

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St Emlyn’s · FRCEM · Practice aid, not an official mark schemeObserver 3 of 3

Abdominal examination

Your task

Starting information

Abdominal examination

Abdominal examination

Preparation

History and general inspection

Hands and pulse

Abdominal examination

Observations

Face and lymph nodes

Abdominal assessment

Abdominal examination

Completion

Finish

Ask the candidate

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